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Joseph F, Jean Simon D, Kondo Tokpovi VC, Kiragu A, Toudeka MRAS, Nazaire R. Trends and factors associated with recent HIV testing among women in Haiti: a cross-sectional study using data from nationally representative surveys. BMC Infect Dis 2024; 24:74. [PMID: 38212702 PMCID: PMC10782569 DOI: 10.1186/s12879-023-08936-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION In the Latin America and Caribbean region, Haiti is one of the countries with the highest rates of HIV. Therefore, this study examined the factors associated with HIV testing among women in Haiti and trends in HIV testing in 2006, 2012, and 2016/17. METHODS Data from the last three Haitian Demographic and Health Surveys (2006, 2012, and 2016/17) were used. The analysis was restricted to women aged of 15-49 years who made their sexual debut. STATA/SE 16.0 was employed to analyze the data by computing descriptive statistics, Chi‑square, and multilevel regression model to describe the trends and identify factors associated with HIV testing in Haiti. P-value less than 0.05 was taken as a significant association. RESULTS HIV testing prevalence increased more than twofold from 2006 (8.8%) to 2017 (21.3%); however, it decreased by 11.6% between 2012 and 2016/17. Additionally, the results indicated that age, place of residence, region, education level, wealth index, mass media exposure, marital status, health insurance, age at first sex and number of sexual partners were significantly associated with HIV testing. CONCLUSIONS To significantly increase HIV testing prevalence among women, the Haitian government must invest much more in their health education while targeting vulnerable groups (youth, women in union, and women with low economic status).
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Affiliation(s)
- Fanor Joseph
- Doctoral School of Social and Human Sciences, University of Antananarivo, Antananarivo, Madagascar
- Bureau d'Etudes Et de Recherche en Statistiques Appliquées, Suivi Et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | - David Jean Simon
- Bureau d'Etudes Et de Recherche en Statistiques Appliquées, Suivi Et Evaluation (BERSA-SE), Port-au-Prince, Haiti.
| | | | - Ann Kiragu
- Department of Law and Political and Social Sciences, University of Sorbonne Paris Nord, Paris, France
| | | | - Roodjmie Nazaire
- Faculté de Médecine et de Pharmacie (FMP), Université d'Etat d'Haïti (UEH), Port-Au-Prince, Haiti
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2
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Gopal S. The case for prioritizing malignant hematology services in low- and middle-income countries. Semin Hematol 2023; 60:189-191. [PMID: 37723025 PMCID: PMC10840687 DOI: 10.1053/j.seminhematol.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
A clear case for can be made for prioritizing malignant hematology services in low- and middle-income countries based on large public health burden, convincing demonstrations of cure and control, innovation opportunities with likely worldwide implications, and sizable returns on investment for health systems and societies. We must now ensure that need and opportunity are matched by commensurate levels of investment and attention.
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Affiliation(s)
- Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD.
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Dare AJ, Bayle A, Hatoqai A, Mungo C, Velilla DG, Soto-Perez-de-Celis E, Gnangnon FHR, Lim MSH, Ralefala T, Mushininga VD. Ensuring Global Access to Cancer Medicines: A Generational Call to Action. Cancer Discov 2023; 13:269-274. [PMID: 36734325 DOI: 10.1158/2159-8290.cd-22-1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 02/04/2023]
Abstract
SUMMARY Essential cancer treatments are not accessible, affordable, or available to patients who need them in many parts of the world. A new Access to Oncology Medicines (ATOM) Coalition, using public-private partnerships, aims to bring essential cancer medicines and diagnostics to patients in low- and lower middle-income countries.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arnauld Bayle
- Oncostat U1018, Inserm, Paris-Saclay University, Gustave Roussy, Villejuif, France
| | - Asma Hatoqai
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Diego Gimenez Velilla
- Departamento de Oncología Radiante, Instituto Nacional del Cáncer (INCAN), Capiatá, Paraguay
| | | | | | - Melissa Siaw Han Lim
- Department of Paraclinical Sciences, Faculty of Medicine and Health Sciences, University Malaysia Sarawak (UNIMAS), Sarawak, Malaysia
| | - Tlotlo Ralefala
- Princess Marina Hospital, Ministry of Health and Wellness, Gaborone, Botswana
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Frimpong SO, Paintsil E. Community engagement in Ebola outbreaks in sub-Saharan Africa and implications for COVID-19 control: A scoping review. Int J Infect Dis 2023; 126:182-192. [PMID: 36462575 DOI: 10.1016/j.ijid.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES There is a paucity of scoping data on the specific roles community engagement played in preventing and managing the Ebola virus disease (EVD) outbreak in sub-Saharan Africa. We assessed the role, benefits, and mechanisms of community engagement to understand its effect on EVD case detection, survival, and mortality in sub-Saharan Africa. The implications for COVID-19 prevention and control were also highlighted. METHODS We searched for articles between 2010 and 2020 in the MEDLINE and Embase databases. The study types included were randomized trials, quasiexperimental studies, observational studies, case series, and reports. RESULTS A total of 903 records were identified for screening. A total of 216 articles met the review criteria, 103 were initially selected, and 44 were included in the final review. Our findings show that effective community involvement during the EVD outbreak depended on the survival rates, testimonials of survivors, risk perception, and the inclusion of community leaders. Community-based interventions improved knowledge and attitudes, case findings, isolation efforts, and treatment uptake. CONCLUSION Although the studies included in this review were of highly variable quality, findings from this review may provide lessons for the role of community engagement in the COVID-19 pandemic's prevention and control in sub-Saharan Africa.
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Affiliation(s)
- Shadrack Osei Frimpong
- Department of Pediatrics, Yale School of Medicine, New Haven, USA; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA; Department of Pharmacology, Yale School of Medicine, New Haven, USA; School of Management, Yale University, New Haven, USA
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Rimawi A, Shah A, Louis H, Scales D, Kheiran JA, Jawabreh N, Yunez S, Horino M, Seita A, Wispelwey B. Community Health Worker Program Outcomes for Diabetes and Hypertension Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200168. [PMID: 36316145 PMCID: PMC9622278 DOI: 10.9745/ghsp-d-22-00168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Community health worker (CHW) programs have proven effective in improving diabetes control in many locations and settings, but data on feasibility and efficacy are lacking in the Middle East and settings of chronic violence. A Palestinian CHW program, Health for Palestine (H4P), addresses chronic diseases in West Bank refugee camps. Our study assesses the feasibility and effectiveness of the program's diabetes and hypertension interventions. METHODS Data on home visits, patient retention, and blood pressure were extracted from the CHW records and analyzed. To assess diabetic patient progress, we conducted a retrospective matched cohort study using data obtained from a United Nations (UN) clinical database to analyze the trajectory of hemoglobin A1c (A1c) values. Thirty of the 47 diabetic patients in the H4P CHW program met study inclusion criteria and were each matched with 3 patients from the Bethlehem UN clinic (n=120). We tested for significance using multivariable linear regression with robust standard errors. RESULTS The average number of home visits per patient per month was 7.3 (standard deviation=4.1), and the patient retention rate was 100% over an average of 11.2 months. For hypertension patients in the CHW program (n=33), mean systolic blood pressure decreased by 7.3 mmHg (95% confidence interval [CI]=1.93, 12.25; P=.009) and mean diastolic blood pressure by 4.3 mmHg (95% CI=0.80, 7.91; P=.018) from March 2018 to November 2019. On average, diabetic patients within the CHW group experienced a 1.4 point greater decline in A1c per year compared to those in the non-CHW group, after adjusting for potential confounders (95% CI=-0.66, -2.1; P<.001). DISCUSSION The results suggest that CHW accompaniment may be an effective model for improving diabetes and hypertension control in refugee camps experiencing direct violence and extreme adversity. A low exclusion cut-off for A1c (≤6.4%) may underestimate the program's impact.
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Affiliation(s)
- Asmaa Rimawi
- Harvard T.H. Chan School of Public Health; Harvard Medical School, Boston, MA, USA
| | - Adarsh Shah
- Harvard Kennedy School, Harvard University, Cambridge, MA, USA
| | - Henry Louis
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David Scales
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jawad Abu Kheiran
- United Nations Relief and Works Agency, Arroub refugee camp, occupied Palestinian territory
| | - Nashat Jawabreh
- Makassad Hospital, East Jerusalem, occupied Palestinian territory
| | - Sofia Yunez
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Masako Horino
- United Nations Relief and Works Agency, Amman, Jordan
| | - Akihiro Seita
- United Nations Relief and Works Agency, Amman, Jordan
| | - Bram Wispelwey
- Brigham and Women's Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Fongkaew K, de Lind van Wijngaarden JW, Tepjan S, Chonwanarat N, Akkakanjanasupar P, Newman PA. 'No test, no disease': Multilevel barriers to HIV testing among young men who have sex with men and transgender women in three semi-urban areas in Thailand. CULTURE, HEALTH & SEXUALITY 2022; 24:1199-1214. [PMID: 34254893 DOI: 10.1080/13691058.2021.1938237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16-20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.
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Affiliation(s)
- Kangwan Fongkaew
- Department of Communication Arts, Faculty of Humanities and Social Sciences, Burapha University, Chonburi, Thailand
| | | | | | | | | | - Peter A Newman
- VOICES-Thailand Foundation, Chiang Mai, Thailand
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Gupta R, Koenig SP. The power of one - in memoriam of Paul E. Farmer. J Int AIDS Soc 2022; 25:e25903. [PMID: 35384298 PMCID: PMC8984239 DOI: 10.1002/jia2.25903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/12/2022] Open
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Internalized stigma, depressive symptoms, and the modifying role of antiretroviral therapy: A cohort study in rural Uganda. SSM - MENTAL HEALTH 2021; 1. [PMID: 35252904 PMCID: PMC8896824 DOI: 10.1016/j.ssmmh.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Depression affects over 40% of people with HIV (PHIV) in low- and middle-income countries, and over half of PHIV report HIV-related internalized stigma. However, few longitudinal studies of PHIV have examined the relationship between HIV-related stigma and depression. Data were analyzed from the 2007–15 Uganda AIDS Rural Treatment Outcomes (UARTO) Study, a cohort of 454 antiretroviral therapy (ART)-naïve PHIV (68% women) starting ART. Our primary outcome was depression symptom severity over the first two years of ART, measured using a locally adapted version of the Hopkins Symptom Checklist; our primary exposure was the 6-item Internalized AIDS-Related Stigma Scale. Both scores were measured at enrollment and at quarterly follow-up visits. We fit linear generalized estimating equations (GEE) regression models to estimate the association between stigma and depression symptom severity, adjusting for potential confounders. We included a stigma×time product term to assess the modifying effect of ART on the association between internalized stigma and depression symptom severity. UARTO participants had a median age of 32 years and median enrollment CD4 count of 217 cells/mm3. Both depression symptom severity and internalized stigma declined on ART, particularly during the first treatment year. In multivariable regression models, depression symptom severity was positively associated with internalized stigma (b=0.03; 95% confidence interval [CI], 0.02 to 0.04) and negatively associated with ART duration >6 months (b =− 0.16; 95% CI,− 0.19 to −0.13). The estimated product term coefficient was negative and statistically significant (P = 0.004), suggesting that the association between internalized stigma and depression symptom severity weakened over time on ART. Thus, in this large cohort of PHIV initiating ART in rural Uganda, depression symptom severity was associated with internalized stigma but the association declined with time on ART. These findings underscore the potential value of ART as a stigma reduction intervention for PHIV, particularly during early treatment.
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9
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Miller AC, Rumaldo N, Soplapuco G, Condeso A, Kammerer B, Lundy S, Faiffer F, Montañez A, Ramos K, Rojas N, Contreras C, Muñoz M, Valdivia H, Vilca D, Córdova N, Hilario P, Vibbert M, Lecca L, Shin S. Success at Scale: Outcomes of Community-Based Neurodevelopment Intervention (CASITA) for Children Ages 6-20 months With Risk of Delay in Lima, Peru. Child Dev 2021; 92:e1275-e1289. [PMID: 34114651 DOI: 10.1111/cdev.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study is a randomized controlled trial of a 12-week community-based group parenting intervention ("CASITA") in Lima, Peru. CASITA improved neurodevelopment in a pilot study of 60 Peruvian children and subsequently scaled to 3,000 households throughout the district. The objective of this study was to assess intervention effectiveness when implemented at scale. A total of 347 children ages 6-20 months (52.7% male, 100% identified as "mestizo") at risk for developmental difficulties were randomized to immediate or delayed CASITA. At 3 months after enrollment, the immediate arm showed significantly higher overall development, based on the Extended Ages and Stages Questionnaire and Home Observation for Measurement of the Environment scores (Cohen's ds = .36 and .31, respectively). Programs demonstrably effective at scale could help address children's development risks worldwide.
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Affiliation(s)
| | | | | | | | | | - Shannon Lundy
- University of California San Francisco Benioff Children's Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sonya Shin
- Harvard Medical School.,Brigham and Women's Hospital
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10
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Retief L, Bennett NC, Bastos ADS. Molecular detection and characterization of novel haemotropic Mycoplasma in free-living mole rats from South Africa. INFECTION GENETICS AND EVOLUTION 2021; 89:104739. [PMID: 33535089 DOI: 10.1016/j.meegid.2021.104739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/08/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022]
Abstract
The importance of haemotropic Mycoplasma (haemoplasma) infections to animal and human health is increasingly recognised. Although wild rodents are known to host these bacteria, haemoplasma prevalence and diversity in small mammals is under-documented, globally. This is due to the reliance on molecular approaches to detect these unculturable, obligate bacteria and to a paucity of assays targeting informative gene regions. We attempted to address these challenges by evaluating the performance of three 16S rRNA PCR assays for detecting Mycoplasma in four African mole-rat species of the family Bathyergidae. This was achieved by screening DNA samples prepared from lung and liver samples of 260 bathyergids, sampled from natural and urban landscapes in the Western Cape Province with one published and two novel conventional PCR assays. Sequence-confirmed Mycoplasma presence guided calculations of the relative sensitivity and specificity of the assays and revealed that 26.5% of the rodents were haemoplasma-positive. Bathyergus suillus sampled near an informal human settlement had a significantly higher infection rate (42%) than the three bathyergid species sampled from natural settings, for which PCR-positivity ranged from 0% to 36%. The 16S rRNA gene phylogeny identified the presence of six Mycoplasma strains in bathyergids that form a novel monophyletic lineage belonging to the haemofelis group, with 16S rRNA and Rnase P gene phylogenies indicating that the bathyergid-associated haemoplasmas were novel and closely related to Mycoplasma coccoides. Assay sensitivity ranged from 60.3% to 76.8% and specificity from 94.8% to 100% and both were highest for the novel assay targeting a ~ 300 bp region of the 16S rRNA gene. Results confirm the presence of novel haemoplasma strains in bathyergid species from South Africa and emphasise the need for expanded studies on haemoplama prevalence, diversity, and transmission routes in other small mammal species from this biodiverse region.
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Affiliation(s)
- Liezl Retief
- Mammal Research Institute, Department of Zoology & Entomology, University of Pretoria, Private Bag 20, Hatfield 0028, South Africa
| | - Nigel C Bennett
- Mammal Research Institute, Department of Zoology & Entomology, University of Pretoria, Private Bag 20, Hatfield 0028, South Africa; South African Research Chair of Mammal Behavioural Ecology and Physiology, Department of Zoology and Entomology, University of Pretoria, Private Bag 20, Hatfield 0028, South Africa
| | - Armanda D S Bastos
- Mammal Research Institute, Department of Zoology & Entomology, University of Pretoria, Private Bag 20, Hatfield 0028, South Africa.
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Harvey M, Neff J, Knight KR, Mukherjee JS, Shamasunder S, Le PV, Tittle R, Jain Y, Carrasco H, Bernal-Serrano D, Goronga T, Holmes SM. Structural competency and global health education. Glob Public Health 2020; 17:341-362. [PMID: 33351721 DOI: 10.1080/17441692.2020.1864751] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.
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Affiliation(s)
- Michael Harvey
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Joshua Neff
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Kelly R Knight
- School of Medicine, University of California, San Francisco, CA, USA
| | - Joia S Mukherjee
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Sriram Shamasunder
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Phuoc V Le
- School of Medicine, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | - Robin Tittle
- Division of Hospital and Specialty Medicine, Portland VA Medical Center, Oregon Health and Sciences University, Portland, OR, USA
| | | | - Héctor Carrasco
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City Campus, Mexico
| | - Daniel Bernal-Serrano
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City Campus, Mexico
| | | | - Seth M Holmes
- Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley, CA, USA
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Bayisenge U, Schurer J, Wong R, Amuguni H, Davey G. Podoconiosis in Rwanda: Knowledge, attitudes and practices among health professionals and environmental officers. PLoS Negl Trop Dis 2020; 14:e0008740. [PMID: 33027253 PMCID: PMC7571685 DOI: 10.1371/journal.pntd.0008740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/19/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background Podoconiosis is a neglected tropical disease commonly found in volcanic regions, where soil is rich in silica. It usually manifests as bilateral lower limb edema. The majority of people affected by podoconiosis are farmers who do not wear shoes. The condition was recently documented in all 30 districts in Rwanda but knowledge, attitudes and practices (KAP) of Rwandan health professionals and environmental officers towards podoconiosis are unknown. Methodology/Findings The objective of this study was to assess the knowledge, attitudes and practices (KAP) of Rwandan health providers and environmental officers towards podoconiosis in order to improve patient healthcare experiences and health outcomes, and to reduce stigma against affected individuals. To achieve this goal, we administered a KAP assessment to physicians (N = 13), nurses/midwives (N = 59), community health workers (N = 226), and environmental officers (N = 38) in the third highest podoconiosis prevalence district in Rwanda (Musanze). All 336 respondents had heard of podoconiosis, but 147 (44%) respondents correctly identified soil as the only direct cause of podoconiosis. The awareness of signs and symptoms and risk groups was lower than any other category (31.5% and 47.5%, respectively). The overall attitude toward podoconiosis was positive (86.1%), with CHWs least likely to harbor negative beliefs against podoconiosis patients. One particular area where most respondents (76%) expressed negative attitude was that they saw people with podoconiosis as a threat to their own health and their family’s health. Prescription of antibiotics and use of ointments/soap to manage wounds was low (5% and 32.2%, respectively), in part due to supply shortages at health facilities. Conclusions This study identified clear gaps in health provider knowledge and practices that affect patient care for those with podoconiosis. Improved access to essential medicines at health facilities and podoconiosis-focused training sessions for practicing health providers are necessary to minimize the burden and stigma of affected individuals. Podoconiosis is a foot disease that progressively affects genetically susceptible people who do not wear shoes in volcanic soil. This disease causes disability, stigma, and impinges on people’s economic productivity. In Rwanda, it is estimated that 6429 people live with podoconiosis, but health services for these particular patients are almost nonexistent. We evaluated knowledge, attitudes and practice among 298 health professionals and 38 environmental officers and found that only 44% of all respondents knew that soil is the only direct cause of podoconiosis. Few health professionals (6%) reported having treated a podoconiosis patient and most health professionals (79%) identified shortages of critical drugs and supplies as an important barrier to providing treatment. Three quarters of environmental officers (74%) did not know that farmers are the people most vulnerable to this condition. The poor knowledge of all respondents toward podoconiosis and the lack of medical supplies suggest that podoconiosis patients likely receive substandard medical care and receive little credible information on prevention. We recommend a multi-sectoral approach to training, as well as the engagement of governments and the World Health Organization, to avail medications and treatment materials in the community.
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Affiliation(s)
- Ursin Bayisenge
- Center for One Health, University of Global Health Equity, Kigali, Rwanda
- * E-mail:
| | - Janna Schurer
- Center for One Health, University of Global Health Equity, Kigali, Rwanda
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, United States of America
| | - Rex Wong
- Center for One Health, University of Global Health Equity, Kigali, Rwanda
- Yale University, Connecticut, United States of America
| | - Hellen Amuguni
- Center for One Health, University of Global Health Equity, Kigali, Rwanda
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, United States of America
| | - Gail Davey
- Centre for Global Health Research, Brighton & Sussex Medical School, Falmer Campus, University of Sussex, Brighton United Kingdom
- School of Public Health, Addis Ababa University, Ethiopia
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13
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Abstract
Mathew Kavanagh and co-authors discuss law reform in the global tuberculosis response.
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14
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Kwan GF, Yan LD, Isaac BD, Bhangdia K, Jean-Baptiste W, Belony D, Gururaj A, Martineau L, Vertilus S, Pierre-Louis D, Fenelon DL, Hirschhorn LR, Benjamin EJ, Bukhman G. High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti. Glob Heart 2020; 15:7. [PMID: 32489780 PMCID: PMC7218772 DOI: 10.5334/gh.388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.Patients attending clinic are less poor than expected from the community.People travelling farther to clinic are less poor.Socioeconomic data should be collected to monitor healthcare access equity.
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Affiliation(s)
- Gene F. Kwan
- Boston University School of Medicine, Boston, MA, US
- Boston Medical Center, Boston, MA, US
- Partners In Health, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | | | | | | | | | | | - Louine Martineau
- Zanmi Lasante, HT
- Tufts New England Medical Center, Boston, MA, US
| | - Serge Vertilus
- Zanmi Lasante, HT
- Hôpital Universitaire de Mirebalais, HT
| | | | | | | | - Emelia J. Benjamin
- Boston University School of Medicine, Boston, MA, US
- Boston University School of Public Health, Boston, MA, US
| | - Gene Bukhman
- Harvard Medical School, Boston, MA, US
- Brigham and Women’s Hospital, Boston, MA, US
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15
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Mokuwa EY, Maat H. Rural populations exposed to Ebola Virus Disease respond positively to localised case handling: Evidence from Sierra Leone. PLoS Negl Trop Dis 2020; 14:e0007666. [PMID: 31961858 PMCID: PMC6994168 DOI: 10.1371/journal.pntd.0007666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/31/2020] [Accepted: 01/04/2020] [Indexed: 01/07/2023] Open
Abstract
At the height of the Ebola epidemic in Sierra Leone in November 2014, a new decentralized approach to ending infection chains was adopted. This approach was based on building local, small-scale Community Care Centres (CCC) intended to serve as triage units for safe handling of patients waiting for test results, with subsequent transfer to Ebola Treatment Centers (ETC) for those who tested positive for Ebola. This paper deals with local response to the CCC, and explains, through qualitative analysis of focus group data sets, why this development was seen in a positive light. The responses of 562 focus group participants in seven villages with CCC and seven neighbouring referral villages without CCC are assessed. These data confirm that CCC are compatible with community values concerning access to, and family care for, the sick. Mixed reactions are reported in the case of "safe burial", a process that directly challenged ritual activity seen as vital to maintaining good relations between socially-enclaved rural families. Land acquisitions to build CCC prompted divided responses. This reflects problems about land ownership unresolved since colonial times between communities and government. The study provides insights into how gaps in understanding between international Ebola responders and local communities can be bridged.
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Affiliation(s)
- Esther Yei Mokuwa
- Development Economics group, Wageningen University, Wageningen, The Netherlands
| | - Harro Maat
- Knowledge, Technology and Innovation group, Wageningen University, Wageningen, The Netherlands
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16
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Wu Z, Wang Y, Detels R, Bulterys M, McGoogan JM. Civil Society Involvement in National HIV/AIDS Programs. HIV/AIDS IN CHINA 2020. [PMCID: PMC7119907 DOI: 10.1007/978-981-13-8518-6_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Globally, the AIDS response relies on active participation of nongovernmental organizations (NGOs) and civil society. In China, the government is the main provider of health and social services, and the role of NGOs is more limited than in other countries. Despite this, China has opened the door for NGO participation in its AIDS response, initially because of donor pressure but increasingly due to official acknowledgment of the important role these groups play in controlling the epidemic. Since the first AIDS NGOs were established in China in the 1990s, Chinese AIDS NGOs have made unique contributions to China’s AIDS response in critical areas like access to drugs, support for treatment compliance, outreach to marginalized at-risk groups, and efforts to reduce stigma among marginalized populations. However, there has been a substantial drop-off in donor funding in recent years, and although the Chinese government has filled the funding gap, demonstrating its commitment to the sector, recent policy moves toward greater control over the work and funding of NGOs threatens their survival. Thus far, China’s AIDS response has been noteworthy, but these new NGO funding and regulatory developments pose significant challenges to the next phase of outreach, prevention, treatment, and care.
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Affiliation(s)
- Zunyou Wu
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yu Wang
- Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA USA
| | - Marc Bulterys
- U.S. Centers for Disease Control and Prevention, Global AIDS Program, China Office, Beijing, China
| | - Jennifer M. McGoogan
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
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17
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Rasmussen JD, Kakuhikire B, Baguma C, Ashaba S, Cooper-Vince CE, Perkins JM, Bangsberg DR, Tsai AC. Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda. PLoS Med 2019; 16:e1002908. [PMID: 31539373 PMCID: PMC6754129 DOI: 10.1371/journal.pmed.1002908] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness. METHODS AND FINDINGS Study participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%-30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%-54%) or believed she brought shame on her family (51%-73%), and most were unwilling to have her marry into their families (80%-88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7-3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5-3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted context that could have influenced stigma and that generalizability beyond rural Uganda may be limited. CONCLUSIONS In a population-based, randomized survey experiment conducted in rural southwestern Uganda, portrayals of effectively treated mental illness did not appear to reduce endorsement of stigmatizing beliefs about mental illness or about persons with mental illness. These findings run counter to evidence from the United States. Further research is necessary to understand the relationship between mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide. TRIAL REGISTRATION The experimental procedures for this study were registered with ClinicalTrials.gov as "Measuring Beliefs and Norms About Persons With Mental Illness" (NCT03656770).
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Affiliation(s)
- Justin D. Rasmussen
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Duke University, Durham, North Carolina, United States of America
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health Sciences University–Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Medical School, Boston, Massachusetts, United States of America
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Ashaba S, Cooper-Vince CE, Vořechovská D, Rukundo GZ, Maling S, Akena D, Tsai AC. Community beliefs, HIV stigma, and depression among adolescents living with HIV in rural Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:169-180. [PMID: 31339461 DOI: 10.2989/16085906.2019.1637912] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The availability of and increased access to antiretroviral therapy (ART) has significantly reduced the morbidity and mortality associated with HIV. As a result, perinatally infected youth are increasingly able to reach adolescence. There is limited information about the psychosocial challenges facing adolescents living with HIV (ALWH) in rural settings of sub-Saharan Africa. We sought to understand psychosocial challenges facing ALWH in rural Uganda and their effects on mental health and HIV treatment outcomes. We conducted 5 focus group discussions and 40 one-on-one in-depth interviews in Mbarara, Uganda with adolescents (aged 13-17 years) and adult women caregivers. All interviews were audio-recorded, transcribed directly into English, and coded using thematic analysis to identify themes related to psychosocial adversities and mental health. Adversities faced by adolescents included negative community perceptions (perceived aggression, presumed early mortality), HIV stigma (enacted and internalized), vulnerability factors (loss of parents, poverty), and health challenges (depression, ART non-adherence). In the conceptual model that emerged from the findings, negative community perceptions (about perceived aggression or presumed early mortality) predisposed ALWH to experience enactments and internalization of stigma that led to depression and ART non-adherence. The data also identified several protective factors, including counselling, family and religious support, and timely serostatus disclosure. Interventions to correct community misperceptions about HIV can potentially reduce stigma and thereby improve physical and mental health outcomes of ALWH.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | | | | | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere College of Health Sciences , Makerere , Uganda
| | - Alexander C Tsai
- Department of Psychiatry, Mbarara University of Science and Technology , Mbarara Uganda.,Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
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19
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Oladele EA, Badejo OA, Obanubi C, Okechukwu EF, James E, Owhonda G, Omeh OI, Abass M, Negedu-Momoh OR, Ojehomon N, Oqua D, Raj-Pandey S, Khamofu H, Torpey K. Bridging the HIV treatment gap in Nigeria: examining community antiretroviral treatment models. J Int AIDS Soc 2019; 21:e25108. [PMID: 29675995 PMCID: PMC5909112 DOI: 10.1002/jia2.25108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 03/26/2018] [Indexed: 11/08/2022] Open
Abstract
Introduction Significant gaps persist in providing HIV treatment to all who are in need. Restricting care delivery to healthcare facilities will continue to perpetuate this gap in limited resource settings. We assessed a large‐scale community‐based programme for effectiveness in identifying people living with HIV and linking them to antiretroviral treatment. Methods A retrospective secular trend study of 14 high burden local government areas of Nigeria was conducted in which two models of community antiretroviral treatment delivery were implemented: Model A (on‐site initiation) and Model B (immediate referral) clusters. Model A cluster offered services within communities, from HIV diagnosis to immediate antiretroviral therapy initiation and some follow‐up. Model B cluster offered services for HIV diagnosis up to baseline evaluation and provided referral for antiretroviral therapy initiation to nearest health facility providing HIV services. For controls, we selected and cluster‐matched 34 local government areas where community antiretroviral treatment delivery was not implemented. Outcomes of interest were: the number of people identified as HIV positive and the number of HIV‐positive individuals started on antiretroviral treatment; from June 2014 to May 2016. We used interrupted time‐series analysis to estimate outcome levels and trends across the pre‐and post‐intervention periods. Results Before community antiretrovial treatment introduction, Model A cluster identified, per 100,000 catchment population, 500 HIV‐positives (95% CI: 399.66 to 601.41) and initiated 216 HIV‐positives on antiretroviral treatment (95% CI: 152.72 to 280.10). Model B cluster identified 32 HIV‐positives (95% CI: 25.00 to 40.51) and initiated 8 HIV‐positives on antiretroviral treatment (95% CI: 5.54 to 10.33). After commART introduction, Model A cluster showed an immediate significant increase in 744 HIV‐positive persons (p = 0.00, 95% CI: 360.35 to 1127.77) and 560 HIV‐positives initiated on treatment (p = 0.00, 95% CI: 260.56 to 859.64). Model B cluster showed an immediate significant increase in 30 HIV‐positive persons identified (p = 0.01, 95% CI: 8.38 to 51.93) but not in the number of HIV‐positives initiated on treatment. Model B cluster showed increased month‐on‐month trends of both outcomes of interest (3.4, p = 0.02, 95% CI: 0.44 to 6.38). Conclusion Both community‐models had similar population‐level effectiveness for rapidly identifying people living with HIV but differed in effectively transitioning them to treatment. Comprehensiveness, integration and attention to barriers to care are important in the design of community antiretroviral treatment delivery.
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Affiliation(s)
- Edward A Oladele
- Prevention, Care and Treatment Department, FHI 360 (Family Health International), Abuja, Nigeria
| | - Okikiolu A Badejo
- Prevention, Care and Treatment Department, FHI 360 (Family Health International), Abuja, Nigeria.,Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Christopher Obanubi
- Prevention, Care and Treatment Department, FHI 360 (Family Health International), Abuja, Nigeria
| | - Emeka F Okechukwu
- Office of HIV/AIDS and TB, U.S. Agency for International Development (USAID), Abuja, Nigeria
| | - Ezekiel James
- Office of HIV/AIDS and TB, U.S. Agency for International Development (USAID), Abuja, Nigeria
| | | | | | - Moyosola Abass
- Monitoring and Evaluation Department, FHI 360 (Family Health International), Abuja, Nigeria
| | | | | | - Dorothy Oqua
- Howard University Global Initiative, Abuja, Nigeria
| | | | | | - Kwasi Torpey
- College of Health Sciences, University of Ghana, Accra, Ghana
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20
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Fan VY. Multi-criteria decision analysis: of politics, policy entrepreneurs, and processes. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:50. [PMID: 30455609 PMCID: PMC6225609 DOI: 10.1186/s12962-018-0131-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Multi-criteria decision analysis (MCDA) has the potential to increase the consistency, transparency and rigour with which these criteria inform decisions. Political context is relevant not only as a motivation for turning to MCDA but also the context in which MCDA can be successfully implemented. A policy entrepreneur can spearhead the creation of a process to carry out MCDA and can help to create and build the capacity of a public institution that observes and convenes this process, an institution that has legal authority to carry out such a function.
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Affiliation(s)
- Victoria Y Fan
- 1Office of Public Health Studies, Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed D204, Honolulu, HI USA.,2François-Xavier Bagnoud Center for Health and Human Rights and the Department of Global Health & Population, Harvard T.H. Chan School of Public Health, 651 Huntington Ave, Boston, MA USA
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The Dark Side of Female HIV Patient Care: Sexual and Reproductive Health Risks in Pre- and Post-Clinical Treatments. J Clin Med 2018; 7:jcm7110402. [PMID: 30384413 PMCID: PMC6262424 DOI: 10.3390/jcm7110402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 12/22/2022] Open
Abstract
This study examines the pre- and post-clinical issues in human immunodeficiency virus (HIV) care and treatment for women and girls of high-risk population groups—namely sex workers, injecting drug users, women living with HIV, primary sexual partners of people living with HIV, adolescent girls who are children of these groups, and migrant young girls and women—in five provinces and cities in Vietnam. Through a sample of 241 surveyed participants and 48 respondents for in-depth interviews and 32 respondents in the focus group discussions, the study identifies multiple barriers that keep these groups from receiving the proper health care that is well within their human rights. Most respondents rated HIV testing as easily accessible, yet only 18.9% of the surveyed women living with HIV disclosed their infection status, while 37.8% gave no information at the most recent prenatal care visit. The level of knowledge and proper practices of sexual and reproductive health (SRH) care also remains limited. Meanwhile, modern birth control methods have yet to be widely adopted among these populations: only 30.7% of respondents reported using condoms when having sex with their husband. This increases the risks of unwanted pregnancy and abortion, as well as vulnerability to sexually transmitted infections (STIs) and HIV transmission. On the other hand, HIV-related stigma and discrimination at health care settings are still pervasive, which create significant barriers for patients to access proper care services. Based on these results, six recommendations to improve SRH status of women and girls of populations at high risk are put forward.
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22
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Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti. World J Surg 2018; 41:3025-3030. [PMID: 28948326 DOI: 10.1007/s00268-017-4246-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program. MATERIALS AND METHODS Patient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area. RESULTS The baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017). DISCUSSION Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.
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Perry HB, Sacks E, Schleiff M, Kumapley R, Gupta S, Rassekh BM, Freeman PA. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects. J Glob Health 2018; 7:010906. [PMID: 28685044 PMCID: PMC5491945 DOI: 10.7189/jogh.07.010906] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As part of our review of the evidence of the effectiveness of community-based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used. METHODS We screened 12 166 published reports in PubMed of community-based approaches to improving maternal, neonatal and child health in high-mortality, resource-constrained settings from 1950-2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation. RESULTS Six categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community-level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community-level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator-led participatory women's groups, and (d) health service provision at outreach sites by mobile health teams. CONCLUSIONS The strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH.
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Affiliation(s)
- Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meike Schleiff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Paul A Freeman
- Independent consultant, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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Community-Based Accompaniment and the Impact of Distance for HIV Patients Newly Initiated on Antiretroviral Therapy: Early Outcomes and Clinic Visit Adherence in Rural Rwanda. AIDS Behav 2018; 22:77-85. [PMID: 28025738 DOI: 10.1007/s10461-016-1658-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Community-based accompaniment (CBA) has been associated with improved antiretroviral therapy (ART) patient outcomes in Rwanda. In contrast, distance has generally been associated with poor outcomes. However, impact of distance on outcomes under the CBA model is unknown. This retrospective cohort study included 537 adults initiated on ART in 2012 in two rural districts in Rwanda. The primary outcomes at 6 months after ART initiation included overall program status, missed a visit and missed three consecutive visits. The associations between cost surface distance (straight-line distance adjusted for surface features) and outcomes were assessed using logistic regression, controlling for potential confounders. Died/lost-to-follow-up and missed three consecutive visits were not associated with distance. Patients within 0-1 km cost surface distance were significantly more likely to miss a visit, potentially due to stigma of attending clinic within one's community. These results suggest that CBA may mediate the impact of long distances on outcomes.
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Abstract
The advent of antiretroviral therapy (ART) in 1996 brought with it an urgent need to develop models of health care delivery that could enable its effective and equitable delivery, especially to patients living in poverty. Community-based care, which stretches from patient homes and communities—where chronic infectious diseases are often best managed—to modern health centers and hospitals, offers such a model, providing access to proximate HIV care and minimizing structural barriers to retention. We first review the recent literature on community-based ART programs in low- and low-to-middle-income country settings and document two key principles that guide effective programs: decentralization of ART services and long-term retention of patients in care. We then discuss the evolution of the community-based programs of Partners In Health (PIH), a nongovernmental organization committed to providing a preferential option for the poor in health care, in Haiti and several countries in sub-Saharan Africa, Latin America, Russia and Kazakhstan. As one of the first organizations to treat patients with HIV in low-income settings and a pioneer of the community-based approach to ART delivery, PIH has achieved both decentralization and excellent retention through the application of an accompaniment model that engages community health workers in the delivery of medicines, the provision of social support and education, and the linkage between communities and clinics. We conclude by showing how PIH has leveraged its HIV care delivery platforms to simultaneously strengthen health systems and address the broader burden of disease in the places in which it works.
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26
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Copeland T. To Keep this Disease from Killing You: Cultural Competence, Consonance, and Health among HIV-positive Women in Kenya. Med Anthropol Q 2017; 32:272-292. [PMID: 28766753 DOI: 10.1111/maq.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 12/26/2022]
Abstract
The HIV/AIDS crisis continues in sub-Saharan Africa, where nearly 70% of infections are found. Despite recent efforts to supply antiretroviral therapy to those infected, most are not receiving medication and are forced to rely on self-management to remain healthy. In Kenya, many of those infected are women living in extreme poverty. This article presents the findings of research among poor women in Nairobi that examined the relationship between knowledge of a cultural model of self-managing HIV/AIDS, cultural consonance, and health. This biocultural study expands on earlier findings showing that knowledge of the model (competence) is a significant predictor of health by examining here how behavior consistent with that knowledge (consonance) affects health outcomes, as measured by CD4 counts, perceived stress, depressive symptoms, and recent illnesses.
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Affiliation(s)
- Toni Copeland
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University
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Sacks E, Swanson RC, Schensul JJ, Gleave A, Shelley KD, Were MK, Chowdhury AM, LeBan K, Perry HB. Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2017; 37:139-149. [PMID: 29086630 DOI: 10.1177/0272684x17738089] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We review 15 frameworks for HSS, highlighting how communities are represented and find few delineated roles for community members or organizations. This review raises the need for a cohesive definition of community involvement in HSS and well-described activities that communities can play in the process. We discuss how communities can engage with HSS in four different areas-planning and priority-setting; program implementation; monitoring, evaluation, and quality improvement; and advocacy-and how these activities could be better incorporated into key HSS frameworks. We argue for more carefully designed interactions between health systems policies and structures, planned health systems improvements, and local communities. These interactions should consider local community inputs, strengths, cultural and social assets, as well as limitations in and opportunities for increasing capacity for better health outcomes.
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Affiliation(s)
- Emma Sacks
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Anna Gleave
- 4 15851 School of Nursing, Johns Hopkins University , Baltimore, MD, USA
| | - Katharine D Shelley
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Karen LeBan
- 7 USAID's Maternal and Child Survival Program (MCSP), 10822 CORE Group , Washington, DC, USA
| | - Henry B Perry
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Auld AF, Valerie Pelletier, Robin EG, Shiraishi RW, Dee J, Antoine M, Desir Y, Desforges G, Delcher C, Duval N, Joseph N, Francois K, Griswold M, Domercant JW, Patrice Joseph YA, Van Onacker JD, Deyde V, Lowrance DW, And The Groupe d'Analyses Salvh. Retention Throughout the HIV Care and Treatment Cascade: From Diagnosis to Antiretroviral Treatment of Adults and Children Living with HIV-Haiti, 1985-2015. Am J Trop Med Hyg 2017; 97:57-70. [PMID: 29064357 PMCID: PMC5676635 DOI: 10.4269/ajtmh.17-0116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Monitoring retention of people living with HIV (PLHIV) in the HIV care and treatment cascade is essential to guide program strategy and evaluate progress toward globally-endorsed 90–90–90 targets (i.e., 90% of PLHIV diagnosed, 81% on sustained antiretroviral therapy (ART), and 73% virally suppressed). We describe national retention from diagnosis throughout the cascade for patients receiving HIV services in Haiti during 1985–2015, with a focus on those receiving HIV services during 2008–2015. Among the 266,256 newly diagnosed PLHIV during 1985–2015, 49% were linked-to-care, 30% started ART, and 18% were retained on ART by the time of database closure. Similarly, among the 192,187 newly diagnosed HIV-positive patients during 2008–2015, 50% were linked to care, 31% started ART, and 19% were retained on ART by the time of database closure. Most patients (90–92%) at all cascade steps were adults (≥ 15 years old), among whom the majority (60–61%) were female. During 2008–2015, outcomes varied significantly across 42 administrative districts (arrondissements) of residence; cumulative linkage-to-care ranged from 23% to 69%, cumulative ART initiation among care enrollees ranged from 2% to 80%, and cumulative ART retention among ART enrollees ranged from 30% to 88%. Compared with adults, children had lower cumulative incidence of ART initiation among care enrollees (64% versus 47%) and lower cumulative retention among ART enrollees (64% versus 50%). Cumulative linkage-to-care was low and should be prioritized for improvement. Variations in outcomes by arrondissement and between adults and children require further investigation and programmatic response.
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Affiliation(s)
- Andrew F Auld
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie Pelletier
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Ermane G Robin
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Ray W Shiraishi
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacob Dee
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mayer Antoine
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Yrvel Desir
- National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Gracia Desforges
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Chris Delcher
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida.,National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Nirva Duval
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Nadjy Joseph
- National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Kesner Francois
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Mark Griswold
- National Alliance of State and Territorial AIDS Directors (NASTAD), Washington, District of Columbia
| | - Jean Wysler Domercant
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Yves Anthony Patrice Joseph
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Joelle Deas Van Onacker
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Varough Deyde
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - David W Lowrance
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - And The Groupe d'Analyses Salvh
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
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29
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De Neve JW, Garrison-Desany H, Andrews KG, Sharara N, Boudreaux C, Gill R, Geldsetzer P, Vaikath M, Bärnighausen T, Bossert TJ. Harmonization of community health worker programs for HIV: A four-country qualitative study in Southern Africa. PLoS Med 2017; 14:e1002374. [PMID: 28792502 PMCID: PMC5549708 DOI: 10.1371/journal.pmed.1002374] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Community health worker (CHW) programs are believed to be poorly coordinated, poorly integrated into national health systems, and lacking long-term support. Duplication of services, fragmentation, and resource limitations may have impeded the potential impact of CHWs for achieving HIV goals. This study assesses mediators of a more harmonized approach to implementing large-scale CHW programs for HIV in the context of complex health systems and multiple donors. METHODS AND FINDINGS We undertook four country case studies in Lesotho, Mozambique, South Africa, and Swaziland between August 2015 and May 2016. We conducted 60 semistructured interviews with donors, government officials, and expert observers involved in CHW programs delivering HIV services. Interviews were triangulated with published literature, country reports, national health plans, and policies. Data were analyzed based on 3 priority areas of harmonization (coordination, integration, and sustainability) and 5 components of a conceptual framework (the health issue, intervention, stakeholders, health system, and context) to assess facilitators and barriers to harmonization of CHW programs. CHWs supporting HIV programs were found to be highly fragmented and poorly integrated into national health systems. Stakeholders generally supported increasing harmonization, although they recognized several challenges and disadvantages to harmonization. Key facilitators to harmonization included (i) a large existing national CHW program and recognition of nongovernmental CHW programs, (ii) use of common incentives and training processes for CHWs, (iii) existence of an organizational structure dedicated to community health initiatives, and (iv) involvement of community leaders in decision-making. Key barriers included a wide range of stakeholders and lack of ownership and accountability of non-governmental CHW programs. Limitations of our study include subjectively selected case studies, our focus on decision-makers, and limited generalizability beyond the countries analyzed. CONCLUSION CHW programs for HIV in Southern Africa are fragmented, poorly integrated, and lack long-term support. We provide 5 policy recommendations to harmonize CHW programs in order to strengthen and sustain the role of CHWs in HIV service delivery.
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Affiliation(s)
- Jan-Walter De Neve
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Kathryn G Andrews
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Nour Sharara
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Chantelle Boudreaux
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Roopan Gill
- University of British Columbia, BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maria Vaikath
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Till Bärnighausen
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Thomas J Bossert
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Ruffell S. Stigma kills! The psychological effects of emotional abuse and discrimination towards a patient with HIV in Uganda. BMJ Case Rep 2017; 2017:bcr-2016-218024. [PMID: 28710190 DOI: 10.1136/bcr-2016-218024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Our patient is a 58-year-old Ugandan woman. After her husband's death in 1994, the patient was forced to leave her home by her late husband's family and arrangements were made for her mother to provide care until her inevitable death. The patient suffered from multiple mental health disturbances as a result of discrimination. Socially isolated after years of self-neglect, she prepared to overdose. In 2007, she became open regarding her status after receiving psychosocial support from various sources. She opened her home as an HIV clinic with the help of a local doctor, and subsequently the majority of her psychological symptoms were resolved. This case illustrates the negative impact that stigma and discrimination can have on mental and consequently physical health, both acutely and chronically. It also highlights the importance of social and psychological support in maintaining the well-being of patients with HIV globally.
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Affiliation(s)
- Simon Ruffell
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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31
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De Neve JW, Boudreaux C, Gill R, Geldsetzer P, Vaikath M, Bärnighausen T, Bossert TJ. Harmonizing community-based health worker programs for HIV: a narrative review and analytic framework. HUMAN RESOURCES FOR HEALTH 2017; 15:45. [PMID: 28673361 PMCID: PMC5496353 DOI: 10.1186/s12960-017-0219-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Many countries have created community-based health worker (CHW) programs for HIV. In most of these countries, several national and non-governmental initiatives have been implemented raising questions of how well these different approaches address the health problems and use health resources in a compatible way. While these questions have led to a general policy initiative to promote harmonization across programs, there is a need for countries to develop a more coherent and organized approach to CHW programs and to generate evidence about the most efficient and effective strategies to ensure their optimal, sustained performance. METHODS We conducted a narrative review of the existing published and gray literature on the harmonization of CHW programs. We searched for and noted evidence on definitions, models, and/or frameworks of harmonization; theoretical arguments or hypotheses about the effects of CHW program fragmentation; and empirical evidence. Based on this evidence, we defined harmonization, introduced three priority areas for harmonization, and identified a conceptual framework for analyzing harmonization of CHW programs that can be used to support their expanding role in HIV service delivery. We identified and described the major issues and relationships surrounding the harmonization of CHW programs, including key characteristics, facilitators, and barriers for each of the priority areas of harmonization, and used our analytic framework to map overarching findings. We apply this approach of CHW programs supporting HIV services across four countries in Southern Africa in a separate article. RESULTS There is a large number and immense diversity of CHW programs for HIV. This includes integration of HIV components into countries' existing national programs along with the development of multiple, stand-alone CHW programs. We defined (i) coordination among stakeholders, (ii) integration into the broader health system, and (iii) assurance of a CHW program's sustainability to be priority areas of harmonization. While harmonization is likely a complex political process, with in many cases incremental steps toward improvement, a wide range of facilitators are available to decision-makers. These can be categorized using an analytic framework assessing the (i) health issue, (ii) intervention itself, (iii) stakeholders, (iv) health system, and (v) broad context. CONCLUSIONS There is a need to address fragmentation of CHW programs to advance and sustain CHW roles and responsibilities for HIV. This study provides a narrative review and analytic framework to understand the process by which harmonization of CHW programs might be achieved and to test the assumption that harmonization is needed to improve CHW performance.
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Affiliation(s)
- Jan-Walter De Neve
- Institute of Public Health, Heidelberg University, Heidelberg, 69120, Germany.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America.
| | - Chantelle Boudreaux
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America
| | - Roopan Gill
- BC Women's Hospital, University of British Columbia, 4500 Oak St, Vancouver, Canada
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America
| | - Maria Vaikath
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America
| | - Till Bärnighausen
- Institute of Public Health, Heidelberg University, Heidelberg, 69120, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Thomas J Bossert
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States of America.
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Abstract
Satish Gopal discusses the challenges of deliverable cancer care and cancer trials in sub-Saharan Africa as well as a potential framework for overcoming these challenges.
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Affiliation(s)
- Satish Gopal
- Malawi Cancer Consortium, Lilongwe, Malawi
- UNC Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- University of Malawi College of Medicine, Blantyre, Malawi
- * E-mail:
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33
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Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Chowdhury AMR, Kirkwood BR, Kureshy N, Lanata CF, Phillips JF, Taylor M, Victora CG, Zhu Z, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel. J Glob Health 2017; 7:010908. [PMID: 28685046 PMCID: PMC5475312 DOI: 10.7189/jogh.07.010908] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. METHODS An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review's findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). RESULTS The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the full use of community-level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence-based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached. CONCLUSIONS Stronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence-based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detection and treatment of HIV/AIDS, tuberculosis, malaria, hypertension, and other chronic diseases. Continued strengthening of CBPHC programs based on rigorous ongoing operations research and evaluation will be required, and this evidence will be needed to guide national and international policies and programs.
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Affiliation(s)
- Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Chairperson, Expert Panel
| | - Carl E Taylor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Former Chairperson, Expert Panel (deceased)
| | - Shobha Arole
- Jamkhed Comprehensive Rural Health Project, Jamkhed, Maharashtra, India
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Abhay Bang
- Society for Education, Action and Research in Community Health, Gadchiroli, Maharashtra, India
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Zulfiqar A Bhutta
- University of Toronto, Toronto, Ontario, Canada
- Aga Khan University, Karachi, Pakistan
- Chairperson, Expert Panel
- Member, Expert Panel
| | | | - Betty R Kirkwood
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Nazo Kureshy
- Bureau of Global Health, United States Agency for International Development, Washington, DC, USA
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Claudio F Lanata
- Institute of Nutritional Research, Lima, Peru
- Chairperson, Expert Panel
- Member, Expert Panel
| | - James F Phillips
- Columbia University Mailman School of Public Health, New York, New York, USA
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Mary Taylor
- Independent Consultant, South Royalton, Vermont, USA
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Cesar G Victora
- Federal University of Pelotas, Pelotas, Brazil
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Zonghan Zhu
- Capital Institute of Pediatrics and China Advisory Center for Child Health, Beijing, China
- Chairperson, Expert Panel
- Member, Expert Panel
| | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Audet CM, Salato J, Vermund SH, Amico KR. Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique. Implement Sci 2017. [PMID: 28407813 DOI: 10.1186/s13012-017-0582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Systematic adaptation of evidence-informed interventions that increase retention in care and improve adherence to antiretroviral therapy (ART) are essential to ending the HIV epidemic in rural sub-Saharan Africa. We selected and adapted an adherence support worker intervention employed in Malawi for use by traditional healers in rural Mozambique. Given the levels of trust and dependence previously expressed by persons living with HIV (PLHIV) for traditional medicine, we adapted the program to engage traditional healers within the allopathic health system. METHODS Adaption followed a theoretically driven approach to intervention adaption: the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) model. Three rounds of performance feedback, based on theater presentations of the adapted intervention for stakeholders and idea generation, were completed with 12 groups from March to July 2016 to develop the final model. We offered healer support to 180 newly diagnosed HIV-infected patients. RESULTS Traditional healers were an acceptable group of community health workers to assist with patient adherence and retention. Traditional healers, clinicians, and interested community members suggested novel strategies to tailor the adherence support worker intervention, revealing a local culture of HIV denialism, aversion to the health system, and dislike of healthcare providers, as well as a preference for traditional treatments. Proposed changes to the intervention included modifications to the training language and topics, expanded community-based activities to support acceptability of an HIV diagnosis and to facilitate partner disclosure, and accompaniment to the health facility by healers to encourage delivery of respectful clinical care. PLHIV, healers, and clinicians deemed the intervention socially acceptable during focus groups. We subsequently recruited 180 newly diagnosed HIV-infected patients into the program: 170 (94%) accepted. CONCLUSIONS Systematic translation of interventions, even between regions with similar social and economic environments, is an important first step to successful program implementation. Efforts previously limited to community health workers can be tailored for use by traditional healers-an underutilized and often maligned health workforce. It proved feasible to use theater-based performances to demonstrate delivery of the intervention in low-literacy populations, generating discussions about social norms, community concerns, and the merits of an acceptable strategy to improve retention and adherence to ART.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
- Departments of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - José Salato
- Friends in Global Health, Quelimane, Mozambique
- Friends in Global Health, Maputo, Mozambique
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Audet CM, Salato J, Vermund SH, Amico KR. Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique. Implement Sci 2017; 12:50. [PMID: 28407813 PMCID: PMC5390357 DOI: 10.1186/s13012-017-0582-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 04/06/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Systematic adaptation of evidence-informed interventions that increase retention in care and improve adherence to antiretroviral therapy (ART) are essential to ending the HIV epidemic in rural sub-Saharan Africa. We selected and adapted an adherence support worker intervention employed in Malawi for use by traditional healers in rural Mozambique. Given the levels of trust and dependence previously expressed by persons living with HIV (PLHIV) for traditional medicine, we adapted the program to engage traditional healers within the allopathic health system. METHODS Adaption followed a theoretically driven approach to intervention adaption: the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) model. Three rounds of performance feedback, based on theater presentations of the adapted intervention for stakeholders and idea generation, were completed with 12 groups from March to July 2016 to develop the final model. We offered healer support to 180 newly diagnosed HIV-infected patients. RESULTS Traditional healers were an acceptable group of community health workers to assist with patient adherence and retention. Traditional healers, clinicians, and interested community members suggested novel strategies to tailor the adherence support worker intervention, revealing a local culture of HIV denialism, aversion to the health system, and dislike of healthcare providers, as well as a preference for traditional treatments. Proposed changes to the intervention included modifications to the training language and topics, expanded community-based activities to support acceptability of an HIV diagnosis and to facilitate partner disclosure, and accompaniment to the health facility by healers to encourage delivery of respectful clinical care. PLHIV, healers, and clinicians deemed the intervention socially acceptable during focus groups. We subsequently recruited 180 newly diagnosed HIV-infected patients into the program: 170 (94%) accepted. CONCLUSIONS Systematic translation of interventions, even between regions with similar social and economic environments, is an important first step to successful program implementation. Efforts previously limited to community health workers can be tailored for use by traditional healers-an underutilized and often maligned health workforce. It proved feasible to use theater-based performances to demonstrate delivery of the intervention in low-literacy populations, generating discussions about social norms, community concerns, and the merits of an acceptable strategy to improve retention and adherence to ART.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Departments of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - José Salato
- Friends in Global Health, Quelimane, Mozambique.,Friends in Global Health, Maputo, Mozambique
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 2017; 389:951-963. [PMID: 28271846 PMCID: PMC5491333 DOI: 10.1016/s0140-6736(17)30402-6] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 11/30/2016] [Indexed: 12/11/2022]
Abstract
The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.
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Affiliation(s)
- Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA.
| | - Brandon A Kohrt
- Department of Psychiatry, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Africa Mental Health Foundation, Nairobi, Kenya
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK
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Domercant JW, Puttkammer N, Young P, Yuhas K, François K, Grand’Pierre R, Lowrance D, Adler M. Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B+ in Haiti. Glob Health Action 2017; 10:1330915. [PMID: 28640661 PMCID: PMC5496080 DOI: 10.1080/16549716.2017.1330915] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/07/2017] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Access to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+. OBJECTIVE To assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti. METHODS Longitudinal data of adult patients initiated on ART from October 2012 through August 2014 at 73 health facilities across Haiti were analyzed using a survival analysis framework to determine levels of attrition. The Kaplan-Meier method and Cox proportional hazards regression were used to examine risk factors associated with attrition. RESULTS Among 17,059 patients who initiated ART, 7627 (44.7%) were non-pregnant women, 5899 (34.6%) were men, and 3533 (20.7%) were Option B+ clients. Attrition from the ART program was 36.7% at 12 months (95% CI: 35.9-37.5%). Option B+ patients had the highest level of attrition at 50.4% at 12 months (95% CI: 48.6-52.3%). While early HIV disease stage at ART initiation was protective among non-pregnant women and men, it was a strong risk factor among Option B+ clients. In adjusted analyses, key protective factors were older age (p < 0.0001), living near the health facility (p = 0.04), having another known HIV-positive household member (p < 0.0001), having greater body mass index (BMI) (p < 0.0001), pre-ART counseling (p < 0.0001), and Cotrimoxazole prophylaxis during baseline (p < 0.01). Higher attrition was associated with rapidly starting ART after enrollment (p < 0.0001), anemia (p < 0.0001), and regimen tenofovir+lamivudine+nevirapine (TDF+3TC+NVP) (p < 0.001). CONCLUSIONS ART attrition in Haiti is high among adults, especially among Option B+ patients. Identifying newly initiated patients most at risk for attrition and providing appropriate interventions could help reduce ART attrition.
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Affiliation(s)
- Jean Wysler Domercant
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Nancy Puttkammer
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Paul Young
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krista Yuhas
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Kesner François
- National AIDS Control Program, Ministry of Health of the Government of Haiti
| | | | - David Lowrance
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Michelle Adler
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Kampala, Uganda
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Tsai AC, Hatcher AM, Bukusi EA, Weke E, Lemus Hufstedler L, Dworkin SL, Kodish S, Cohen CR, Weiser SD. A Livelihood Intervention to Reduce the Stigma of HIV in Rural Kenya: Longitudinal Qualitative Study. AIDS Behav 2017; 21:248-260. [PMID: 26767535 DOI: 10.1007/s10461-015-1285-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The scale-up of effective treatment has partially reduced the stigma attached to HIV, but HIV still remains highly stigmatized throughout sub-Saharan Africa. Most studies of anti-HIV stigma interventions have employed psycho-educational strategies such as information provision, counseling, and testimonials, but these have had varying degrees of success. Theory suggests that livelihood interventions could potentially reduce stigma by weakening the instrumental and symbolic associations between HIV and premature morbidity, economic incapacity, and death, but this hypothesis has not been directly examined. We conducted a longitudinal qualitative study among 54 persons with HIV participating in a 12-month randomized controlled trial of a livelihood intervention in rural Kenya. Our study design permitted assessment of changes over time in the perspectives of treatment-arm participants (N = 45), as well as an understanding of the experiences of control arm participants (N = 9, interviewed only at follow-up). Initially, participants felt ashamed of their seropositivity and were socially isolated (internalized stigma). They also described how others in the community discriminated against them, labeled them as being "already dead," and deemed them useless and unworthy of social investment (perceived and enacted stigma). At follow-up, participants in the treatment arm described less stigma and voiced positive changes in confidence and self-esteem. Concurrently, they observed that other community members perceived them as active, economically productive, and contributing citizens. None of these changes were noted by participants in the control arm, who described ongoing and continued stigma. In summary, our findings suggest a theory of stigma reduction: livelihood interventions may reduce internalized stigma among persons with HIV and also, by targeting core drivers of negative attitudes toward persons with HIV, positively change attitudes toward persons with HIV held by others. Further research is needed to formally test these hypotheses, assess the extent to which these changes endure over the long term, and determine whether this class of interventions can be implemented at scale.
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Mental health training for secondary school teachers in Haiti: a mixed methods, prospective, formative research study of feasibility, acceptability, and effectiveness in knowledge acquisition. Glob Ment Health (Camb) 2017; 4:e4. [PMID: 28596905 PMCID: PMC5454794 DOI: 10.1017/gmh.2016.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/13/2016] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Engagement and training of educators in student mental health holds promise for promoting access to care as a task sharing strategy but has not been well-studied in low-income regions. METHODS We used a prospective and convergent mixed methods design to evaluate a customized school mental health 2½ day training for teachers in rural Haiti (n = 22) as the initial component of formative research developing a school-based intervention to promote student mental health. Training prepared teachers to respond to student mental health needs by providing psychoeducational and practical support to facilitate access to care. We examined level of participation and evaluated feasibility, acceptability, and perceived effectiveness by calculating mean scores on self-report Likert-style items eliciting participant experience. We examined effectiveness of the training on improving mental health knowledge and attitudes by comparing mean scores on an assessment administered pre- and post-training. Finally, we examined self-report written open-ended responses and focus group discussion (FGD) interview data bearing on perceived feasibility, acceptability, and effectiveness to contextualize participant ratings of training and to identify recommendations for enhancing the utility of mental health training locally for educators. RESULTS Mean scores of knowledge and attitudes significantly improved between the pre-test and post-tests; e.g., knowledge improved from 58% correct at baseline to 68% correct on the second post-test (p = 0.039). Mean ratings of the training were favorable across all categories and FGD data demonstrated widespread participant endorsement of training acceptability and effectiveness; participants recommended extending the duration and number of training sessions. CONCLUSIONS Findings support feasibility, acceptability, and a limited scope of effectiveness of brief mental health training for secondary school teachers in Haiti. Further development of approaches to engage teachers in promoting school mental health through training is warranted.
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Kaphle S, Matheke-Fischer M, Lesh N. Effect of Performance Feedback on Community Health Workers' Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial. JMIR Public Health Surveill 2016; 2:e169. [PMID: 27927607 PMCID: PMC5177738 DOI: 10.2196/publichealth.3381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/14/2015] [Accepted: 03/14/2016] [Indexed: 11/14/2022] Open
Abstract
Background Small-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years. Objective The paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change. Methods In a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention. Results We found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass’s delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass’s delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results. Conclusions Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation.
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Affiliation(s)
- Sangya Kaphle
- Dimagi Software Innovations, Cambridge, MA, United States
| | | | - Neal Lesh
- Dimagi Software Innovations, Cambridge, MA, United States
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Reddock JR. Assessing the Right to Health in the Sixth Millennium Development Goal in the Eastern Caribbean. WORLD MEDICAL & HEALTH POLICY 2016. [DOI: 10.1002/wmh3.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Murphy JW, Schlaerth CA. Emergence, Construction, and Authorial Intent in Community-based Projects. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0160597616628909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The focus of community-based projects is participation. This idea has both an epistemological and a logistical dimension. Local knowledge is supposed to guide these investigations, while community members should participate in every phase of a project. In fact, some critics argue that they should control these undertakings. In this way, the “authorial intent” of these persons can be given serious attention, thereby improving social services. These requirements, in many ways, take the usual debate between quantitative and qualitative methodologies in a new direction.
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Abstract
Much of the current health approach to designing HIV/AIDS interventions in resource-poor settings involves behavior-change initiatives, particularly those adopting education-based and “culturally competent” frameworks for the reduction of HIV-associated “risk behaviors.” This article reviews the evidence and social assumptions behind this approach to preventing HIV transmission, and argues that these approaches are often inadequate or misguided, particularly in their conflation of the concept of “culture” with social circumstances. By analyzing the socioeconomic circumstances that constrain individual agency, and by combining data from prevention literature with analyses of international trade agreements and the controversies over antiretroviral drug distribution, the author argues that the movement of capital and the maintenance of inequality are central to the problems associated with behavior-change initiatives and must be addressed through new paradigms in order to respond appropriately to the global AIDS pandemic. Hardt and Negri's paradigm of “Empire”—that is, examining the system through which social inequalities are maintained not only between countries but also within them—offers prospects for the design of new interventions and targets for public health workers and social movements.
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Affiliation(s)
- Sanjay Basu
- Program in Infectious Disease and Social Change, Yale University School of Medicine, New Haven, CT 06510, USA.
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Lachenal G, Owona Ntsama J, Ze Bekolo D, Kombang Ekodogo T, Manton J. Neglected Actors in Neglected Tropical Diseases Research: Historical Perspectives on Health Workers and Contemporary Buruli Ulcer Research in Ayos, Cameroon. PLoS Negl Trop Dis 2016; 10:e0004488. [PMID: 27101371 PMCID: PMC4839562 DOI: 10.1371/journal.pntd.0004488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Guillaume Lachenal
- SPHERE UMR 7219, Université Paris Diderot and Institut Universitaire de France, Paris, France
- * E-mail: (GL); (JM)
| | - Joseph Owona Ntsama
- Fondation Paul Ango Ela pour la Géopolitique en Afrique Centrale, Yaoundé, Cameroon
| | | | | | - John Manton
- Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: (GL); (JM)
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Engebretsen E, Heggen K, Das S, Farmer P, Ottersen OP. Paradoxes of sustainability with consequences for health. THE LANCET GLOBAL HEALTH 2016; 4:e225-6. [DOI: 10.1016/s2214-109x(16)00038-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 11/16/2022] Open
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Pronyk P, Rogers B, Lee S, Bhatnagar A, Wolman Y, Monasch R, Hipgrave D, Salama P, Kucharski A, Chopra M. The Effect of Community-Based Prevention and Care on Ebola Transmission in Sierra Leone. Am J Public Health 2016; 106:727-32. [PMID: 26890176 DOI: 10.2105/ajph.2015.303020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the acceptability, use, effects on early isolation, and contribution to Ebola virus disease (EVD) transmission of Community Care Centers (CCCs), which were rapidly deployed in Sierra Leone during an accelerated phase of the 2014-2015 EVD epidemic. METHODS Focus group discussions, triads, and key informant interviews assessed acceptability of the CCCs. Facility registers, structured questionnaires, and laboratory records documented use, admission, and case identification. We estimated transmission effects by comparing time between symptom onset and isolation at CCCs relative to other facilities with the national Viral Hemorrhagic Fever data set. RESULTS Between November 2014 and January 2015, 46 CCCs were operational. Over 13 epidemic weeks, 6129 patients were triaged identifying 719 (12%) EVD suspects. Community acceptance was high despite initial mistrust. Nearly all patients presented to CCCs outside the national alert system. Isolation of EVD suspects within 4 days of symptoms was higher in CCCs compared with other facilities (85% vs 49%; odds ratio = 6.0; 95% confidence interval = 4.0, 9.1), contributing to a 13% to 32% reduction in the EVD reproduction number (Ro). CONCLUSIONS Community-based approaches to prevention and care can reduce Ebola transmission.
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Affiliation(s)
- Paul Pronyk
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Braeden Rogers
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Sylvia Lee
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Aarunima Bhatnagar
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Yaron Wolman
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Roeland Monasch
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - David Hipgrave
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Peter Salama
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Adam Kucharski
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Mickey Chopra
- Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
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Treves-Kagan S, Steward WT, Ntswane L, Haller R, Gilvydis JM, Gulati H, Barnhart S, Lippman SA. Why increasing availability of ART is not enough: a rapid, community-based study on how HIV-related stigma impacts engagement to care in rural South Africa. BMC Public Health 2016; 16:87. [PMID: 26823077 PMCID: PMC4730651 DOI: 10.1186/s12889-016-2753-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/19/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Stigma is a known barrier to HIV testing and care. Because access to antiretroviral therapy reduces overt illness and mortality, some scholars theorized that HIV-related stigma would decrease as treatment availability increased. However, the association between ART accessibility and stigma has not been as straightforward as originally predicted. METHODS We conducted a "situational analysis"--a rapid, community-based qualitative assessment to inform a combination HIV prevention program in high prevalence communities. In the context of this community-based research, we conducted semi-structured interviews and focus groups with 684 individuals in four low-resource sub-districts in North West Province, South Africa. In addition to using this data to inform programming, we examined the impact of stigma on the uptake of services. RESULTS Findings suggested that anticipated stigma remains a barrier to care. Although participants reported less enacted stigma, or hostility toward people living with HIV, they also felt that HIV remains synonymous with promiscuity and infidelity. Participants described community members taking steps to avoid being identified as HIV-positive, including avoiding healthcare facilities entirely, using traditional healers, or paying for private doctors. Such behaviors led to delays in testing and accessing care, and problems adhering to medications, especially for men and youth with no other health condition that could plausibly account for their utilization of medical services. CONCLUSIONS We conclude that providing access to ART alone will not end HIV-related stigma. Instead, individuals will remain hesitant to seek care as long as they fear that doing so will lead to prejudice and discrimination. It is critical to combat this trend by increasing cultural acceptance of being seropositive, integrating HIV care into general primary care and normalizing men and youths' accessing health care.
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Affiliation(s)
- Sarah Treves-Kagan
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
| | - Wayne T Steward
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
| | - Lebogang Ntswane
- University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
| | - Robin Haller
- University of California, San Francisco, Global Health Sciences, San Francisco, CA, USA.
| | - Jennifer M Gilvydis
- University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
| | - Harnik Gulati
- University of Washington, International Training and Education Center for Health, Seattle, WA, USA.
| | - Scott Barnhart
- University of Washington, International Training and Education Center for Health, Seattle, WA, USA.
| | - Sheri A Lippman
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
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Phuphanich M, Rattanamahattana M, Avihingsanon A, Chetchotisakd P, Putcharoen O, Gandhi M, Sohn AH, Imrie J, Phanuphak P, Kerr SJ. A qualitative assessment of barriers and facilitators to antiretroviral adherence in Thai patients. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30692-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tapela NM, Mpunga T, Karema N, Nzayisenga I, Fadelu T, Uwizeye FR, Hirschhorn LR, Muhimpundu MA, Balinda JP, Amoroso C, Wagner CM, Binagwaho A, Shulman LN. Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery. J Clin Oncol 2015; 34:43-52. [PMID: 26578617 DOI: 10.1200/jco.2015.61.7738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science-the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed-is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. METHODS The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. RESULTS Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. CONCLUSION Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.
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Affiliation(s)
- Neo M Tapela
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA.
| | - Tharcisse Mpunga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Nadine Karema
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Ignace Nzayisenga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Temidayo Fadelu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Frank R Uwizeye
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lisa R Hirschhorn
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Marie Aimee Muhimpundu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Jean Paul Balinda
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Cheryl Amoroso
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Claire M Wagner
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Agnes Binagwaho
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lawrence N Shulman
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
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Moyer E. The Anthropology of Life After AIDS: Epistemological Continuities in the Age of Antiretroviral Treatment. ANNUAL REVIEW OF ANTHROPOLOGY 2015. [DOI: 10.1146/annurev-anthro-102214-014235] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Anthropologists working on HIV are increasingly reframing their research as taking place in “the age of treatment,” marking a shift from “the age of AIDS.” The age of treatment is characterized by the increasing biomedicalization of HIV, which has come about as a result of improved pharmaceutical and surveillance technologies and the presumption by international experts in global health that HIV could be eradicated in the near future through biomedical interventions. Despite this radical transformation, I argue that there are many important epistemological continuities for anthropologists researching HIV/AIDS in the twenty-first century. This review identifies such continuities between anthropological research conducted prior to and that conducted since the availability of life-saving treatment for HIV.
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Affiliation(s)
- Eileen Moyer
- Department of Anthropology, University of Amsterdam, 1001 NA Amsterdam, The Netherlands
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